[ 摘要 ]

台灣地區山地鄉結核病發生率及死亡率，均高於非山地鄉，且結核病服藥完成率普遍偏低，因此為提高山地鄉服藥遵從率，86年3月首先在山地鄉開始實施直接觀察短程治療（DOTS）。但從未評值直接觀察短程治療的實施情形與服藥遵從效果，因此本研究主要目的在了解山地鄉肺結核原住民接受直接觀察短程治療情形、對肺結核疾病的知識、健康信念、由家人親友及治療觀察員得到的社會支持與影響肺結核服藥遵從因素。本研究以問卷為工具，針對142位山地鄉肺結核原住民，採面對面訪談方式收集資料，結果發現：

山地鄉DOTS實施情形，治療觀察員多由家人擔任，43.7%的受試者不知道治療觀察員是誰及40.8﹪不覺得每天有人督促他們服藥，顯示治療觀察員沒有確實執行監督服藥的職責。山地鄉肺結核原住民服藥遵從者（治療肺結核期間未連續中斷藥物超過14天）佔55.6﹪，顯示中斷藥物情形嚴重。

至於對肺結核疾病知識方面普遍偏低，其中以「為防止肺結核的傳染，與結核病人分開使用碗筷及酒杯」、「抽煙太多會得到肺結核」、「所有得到肺結核的病人都會傳染」、「喝酒太多會得到肺結核」、「所有得到肺結核的人一定會咳嗽」及「工作太累會引起肺結核」是答對率最低六題，未達滿分一半。

在肺結核的五種信念中，以自覺服藥利益得分最高，自覺服藥障礙得分最低。拿藥障礙原因分析以路途太遠是最主要原因。至於在社會支持與服藥遵從性部分家人親友及治療觀察員的社會支持普遍高，支持的功能上均以情緒性支持得分最高，訊息性支持得分最低。影響因素分析顯示只有服藥正向動機與服藥遵從性有關。



[ 英文摘要 ]

As is widely known, the incidence and mortality rate of pulmonary tuberculosis are much higher in the mountainous regions than in the non- mountainous regions of Taiwan. In order to improve the ratio of complete treatment for pulmonary tuberculosis in the mountainous regions, DOTS was first implemented in March, 1997. However, an objective evaluation of the relationship between the effect of DOTS and drug compliance has never been conducted. The purpose of this study is to investigate how such factors as implementation of DOTS, knowledge of pulmonary tuberculosis, health belief and the social support from the patient’s family, friends and observer have affected his/her drug compliance. In this study, 142 aboriginal patients with pulmonary tuberculosis in seven mountainous regions were asked to complete the questionnaires and then interviewed by the twelve well-trained interviewers. The results are as follows:

Most of the treatment observers were members of the patient’s family as DOTS was implemented in the mountainous regions. 43.7% of the patients did not know who their observer was. 40.8% of the patients said that no one was present to remind them to take the medication during the period of treatment. This finding suggests that the observers failed to fulfill the responsibility of monitoring patients while patients took the drug. The rate of the compliant patients (those who did not stop taking medication for more than 14 successive days) was only 55.6%, which indicates that the problem of patients’ stopping taking medication is serious.

Patients’ knowledge of pulmonary tuberculosis was inadequate. More than half of the patients failed to answer the following six true-false questions correctly. These questions are: (1) “Using separate bowls and wineglasses can prevent the transmission of pulmonary tuberculosis”; (2) “Smoking too much can cause pulmonary tuberculosis”; (3) “All pulmonary tuberculosis patients will transmit the disease”; (4) “ Drinking too much can cause pulmonary tuberculosis”; (5) “All patients of pulmonary tuberculosis will cough”, and (6) “Working too hard can cause pulmonary tuberculosis”.

The findings indicate perceived benefits scored highest and perceived barriers scored lowest in the five beliefs of pulmonary tuberculosis. Of all the barriers that keep patients from getting their medicine, traveling long distances to get their refills was the greatest one. As for the social support from family, friends and observers, the percentage was generally high. Of all the types of support, emotional support scored highest and information support scored lowest. Statistical analysis showed that positive motivation to take drugs was associated with drug compliance.